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H34.8131 ICD-10-CM Code: Central retinal vein occlusion, bilateral, with retinal neovascularization

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
1 Excludes1
Risk adjustment
CMS-HCC V28: 1 category

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 123 — NEUROLOGICAL EYE DISORDERS (MDC 02)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for H34.8131 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on H34.8131 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from H34

7th Character Guide

"One of the following 7th characters is to be assigned to codes in subcategory H34.81 to designate the severity of the occlusion:"

  • 0 — with macular edema
  • 1 — with retinal neovascularization (this page’s code)
  • 2 — stable

Variant codes in this family

H34.8130, H34.8131, H34.8132

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for H34.8131

MedCoder structured workflow — derived from this code’s own official record

Before you code H34.8131

  1. A 7th character is required in this family. Confirm the documentation supports the character assigned — its meaning in this family is defined in the official instruction. This page’s code carries “1”. The official 7th-character definitions for this family are quoted in the guide.

    See the 7th Character Guide

  2. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: bilateral). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

    See the relationships section · Guide: Laterality coding →

  3. H34.8131’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  4. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with H34.8131. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in H34.8131’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewG45.3

  2. Is the side documented?
    Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
    No → Use the unspecified-side code only when the record states no side; a query is the alternative.
  3. Does the documentation support one of this family’s 7th-character values?
    Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
    No → The code is invalid without its 7th character — query for the missing element.

Consider H34.8131. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Laterality
Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).
7th-character basis
The documented element this family’s 7th character records (see the official definitions in the 7th Character Guide).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).

Official instructions as workflow

  • Excludes1 — check before selecting H34.8131(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with H34.8131: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareG45.3

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition H34.8131 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewG45.3

Documentation: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is H34.8131 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse H34.8131 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of H34.8131 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • G45.3— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of amaurosis fugax moves the case to G45.3; the two are not reported together unless documented as unrelated.

    Full comparison: H34.8131 vs G45.3 →

  • H34.8130— Encounter relationship (Review)

    Same underlying diagnosis, different encounter phase.

    The same diagnosis at a different phase of care; one encounter takes one 7th character.

    What moves you there: Documentation of a with macular edema moves the case to H34.8130.

    Full comparison: H34.8131 vs H34.8130 →

  • H34.8132— Encounter relationship (Review)

    Same underlying diagnosis, different encounter phase.

    The same diagnosis at a different phase of care; one encounter takes one 7th character.

    What moves you there: Documentation of a stable moves the case to H34.8132.

    Full comparison: H34.8131 vs H34.8132 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Central retinal vein occlusion, bilateral, with retinal neovascularization is a billable ICD-10-CM diagnosis code (H34.8131).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
  2. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
  3. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • CC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name H34.8131 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes2 note: I74 — Arterial embolism and thrombosis (via H34.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 46 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 1 MS-DRG: DRG 123 (MDC 02).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):EYE005 — Retinal and vitreous conditions (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

H34.232 — Retinal artery branch occlusion, left eye, H34.233 — Retinal artery branch occlusion, bilateral, H34.239 — Retinal artery branch occlusion, unspecified eye, H34.8110 — Central retinal vein occlusion, right eye, with macular edema, H34.8111 — Central retinal vein occlusion, right eye, with retinal neovascularization, H34.8112 — Central retinal vein occlusion, right eye, stable, H34.8120 — Central retinal vein occlusion, left eye, with macular edema, H34.8121 — Central retinal vein occlusion, left eye, with retinal neovascularization, H34.8122 — Central retinal vein occlusion, left eye, stable, H34.8130 — Central retinal vein occlusion, bilateral, with macular edema, H34.8132 — Central retinal vein occlusion, bilateral, stable, H34.8190 — Central retinal vein occlusion, unspecified eye, with macular edema, H34.8191 — Central retinal vein occlusion, unspecified eye, with retinal neovascularization, H34.8192 — Central retinal vein occlusion, unspecified eye, stable, H34.821 — Venous engorgement, right eye, H34.822 — Venous engorgement, left eye, H34.823 — Venous engorgement, bilateral, H34.829 — Venous engorgement, unspecified eye, H34.8310 — Tributary (branch) retinal vein occlusion, right eye, with macular edema, H34.8311 — Tributary (branch) retinal vein occlusion, right eye, with retinal neovascularization, +25 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage) for risk-adjusted payment.

E13.3592 — Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye, E13.3593 — Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral, E13.3599 — Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye, H34.8110 — Central retinal vein occlusion, right eye, with macular edema, H34.8111 — Central retinal vein occlusion, right eye, with retinal neovascularization, H34.8112 — Central retinal vein occlusion, right eye, stable, H34.8120 — Central retinal vein occlusion, left eye, with macular edema, H34.8121 — Central retinal vein occlusion, left eye, with retinal neovascularization, H34.8122 — Central retinal vein occlusion, left eye, stable, H34.8130 — Central retinal vein occlusion, bilateral, with macular edema, H34.8132 — Central retinal vein occlusion, bilateral, stable, H34.8190 — Central retinal vein occlusion, unspecified eye, with macular edema, H34.8191 — Central retinal vein occlusion, unspecified eye, with retinal neovascularization, H34.8192 — Central retinal vein occlusion, unspecified eye, stable, H34.8310 — Tributary (branch) retinal vein occlusion, right eye, with macular edema, H34.8311 — Tributary (branch) retinal vein occlusion, right eye, with retinal neovascularization, H34.8312 — Tributary (branch) retinal vein occlusion, right eye, stable, H34.8320 — Tributary (branch) retinal vein occlusion, left eye, with macular edema, H34.8321 — Tributary (branch) retinal vein occlusion, left eye, with retinal neovascularization, H34.8322 — Tributary (branch) retinal vein occlusion, left eye, stable, +159 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Retinal and vitreous conditions).

+747 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Occlusion, occluded”; these codes share that main term but sit in a different category of the Tabular List.

G91.1 — Obstructive hydrocephalus (ventricle NEC), I24.0 — Acute coronary thrombosis not resulting in myocardial infarction (artery, coronary), I25.2 — Old myocardial infarction (coronary, healed or old), I25.82 — Chronic total occlusion of coronary artery (coronary, total), I63.00 — Cerebral infarction due to thrombosis of unspecified precerebral artery (artery, precerebral, with infarction, due to, thrombosis), I63.01 — Cerebral infarction due to thrombosis of vertebral artery (artery, vertebral, with, infarction, due to, thrombosis), I63.02 — Cerebral infarction due to thrombosis of basilar artery (artery, basilar, with, infarction, due to, thrombosis), I63.03 — Cerebral infarction due to thrombosis of carotid artery (artery, carotid, with, infarction, due to, thrombosis), I63.09 — Cerebral infarction due to thrombosis of other precerebral artery (artery, precerebral, specified NEC, with infarction, due to, thrombosis), I63.10 — Cerebral infarction due to embolism of unspecified precerebral artery (artery, precerebral, with infarction, due to, embolism), I63.11 — Cerebral infarction due to embolism of vertebral artery (artery, vertebral, with, infarction, due to, embolism), I63.12 — Cerebral infarction due to embolism of basilar artery (artery, basilar, with, infarction, due to, embolism), I63.13 — Cerebral infarction due to embolism of carotid artery (artery, carotid, with, infarction, due to, embolism), I63.19 — Cerebral infarction due to embolism of other precerebral artery (artery, precerebral, specified NEC, with infarction, due to, embolism), I63.20 — Cerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries (artery, precerebral, with infarction), I63.21 — Cerebral infarction due to unspecified occlusion or stenosis of vertebral arteries (artery, vertebral, with, infarction), I63.22 — Cerebral infarction due to unspecified occlusion or stenosis of basilar artery (artery, basilar, with, infarction), I63.23 — Cerebral infarction due to unspecified occlusion or stenosis of carotid arteries (artery, carotid, with, infarction), I63.29 — Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries (artery, precerebral, specified NEC, with infarction), I63.3 — Cerebral infarction due to thrombosis of cerebral arteries (artery, brain or cerebral, with infarction, thrombosis), +71 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of H34.8131 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run H34.8131 with this related code in Claim Check

Hierarchy

Referenced by Excludes2 notes

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 298 — Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hemorrhage [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2027
  • DRG 123 — NEUROLOGICAL EYE DISORDERS[MS-DRG]: “NEUROLOGICAL EYE DISORDERS (MDC 02)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027

MDC crossing

  • MDC 02 — Diseases and Disorders of the Eye[MDC crossing]: “Diseases and Disorders of the Eye — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,200 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Nearest codes (40)

Change history

Common coding questions

Does H34.8131 require a 7th character?

Yes. One of the following 7th characters is to be assigned to codes in subcategory H34.81 to designate the severity of the occlusion:.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "H34.8131 — Central retinal vein occlusion, bilateral, with retinal neovascularization." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/h34.8131-central-retinal-vein-occlusion-bilateral-with-retinal-neovascularization

Change history

  • FY2017 — October 1, 2016
    Added to the code set
    Central retinal vein occlusion, bilateral, with retinal neovascularization
    FY2017 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to H34.8131 in its code family, with their registry titles.

View all codes in the H34 family